诊断老年癫痫患者的认知障碍。
Diagnosing cognitive disorders in older adults with epilepsy.
机构信息
Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
出版信息
Epilepsia. 2021 Feb;62(2):460-471. doi: 10.1111/epi.16780. Epub 2020 Dec 1.
OBJECTIVE
To characterize the nature and prevalence of cognitive disorders in older adults with temporal lobe epilepsy (TLE) and compare their cognitive profiles to patients with amnestic mild cognitive impairment (ie, aMCI).
METHODS
Seventy-one older patients with TLE, 77 aMCI, and 69 normal aging controls (NACs), all 55-80 years of age, completed neuropsychological measures of memory, language, executive function, and processing speed. An actuarial neuropsychological method designed to diagnose MCI was applied to individual patients to identify older adults with TLE who met diagnostic criteria for MCI (TLE-MCI). A linear classifier was performed to evaluate how well the diagnostic criteria differentiated patients with TLE-MCI from aMCI. In TLE, the contribution of epilepsy-related and vascular risk factors to cognitive impairment was evaluated using multiple regression.
RESULTS
Forty-three TLE patients (60%) met criteria for TLE-MCI, demonstrating marked deficits in both memory and language. When patients were analyzed according to age at seizure onset, 63% of those with an early onset (<50 years) versus 56% of those with late onset (≥ 50 years) met criteria for TLE-MCI. A classification model between TLE-MCI and aMCI correctly classified 81.1% (90.6% specificity, 61.3% sensitivity) of the cohort based on neuropsychological scores. Whereas TLE-MCI showed greater deficits in language relative to aMCI, patients with aMCI showed greater rapid forgetting on memory measures. Both epilepsy-related risk factors and the presence of leukoaraiosis on MRI contributed to impairment profiles in TLE-MCI.
SIGNIFICANCE
Cognitive impairment is a common comorbidity in epilepsy and it presents in a substantial number of older adults with TLE. Although the underlying etiologies are unknown in many patients, the TLE-MCI phenotype may be secondary to an accumulation of epilepsy and vascular risk factors, signal the onset of a neurodegenerative disease, or represent a combination of factors.
目的
描述老年颞叶癫痫（TLE）患者认知障碍的性质和流行程度，并将其认知特征与遗忘型轻度认知障碍（aMCI）患者进行比较。
方法
共有 71 名年龄在 55-80 岁的老年 TLE 患者、77 名 aMCI 患者和 69 名正常老化对照者（NAC）完成了记忆、语言、执行功能和处理速度的神经心理学测试。应用一种旨在诊断 MCI 的计算神经心理学方法对个体患者进行评估，以确定符合 MCI 诊断标准的 TLE 患者（TLE-MCI）。采用线性分类器评估诊断标准如何区分 TLE-MCI 患者和 aMCI 患者。在 TLE 中，使用多元回归评估与癫痫相关和血管危险因素对认知障碍的影响。
结果
43 名 TLE 患者（60%）符合 TLE-MCI 标准，表现出记忆和语言方面的明显缺陷。当根据发病年龄对患者进行分析时，63%的早发性（<50 岁）患者与 56%的晚发性（≥50 岁）患者符合 TLE-MCI 标准。基于神经心理学评分，TLE-MCI 和 aMCI 之间的分类模型正确分类了队列中的 81.1%（特异性 90.6%，敏感性 61.3%）。尽管 TLE-MCI 患者在语言方面的缺陷较 aMCI 患者更严重，但 aMCI 患者在记忆测试中快速遗忘的程度更大。与 MRI 上的白质疏松症一样，与癫痫相关的危险因素也会导致 TLE-MCI 患者的认知障碍。
意义
认知障碍是癫痫的常见合并症，在很大一部分老年 TLE 患者中存在。尽管许多患者的潜在病因尚不清楚，但 TLE-MCI 表型可能是由于癫痫和血管危险因素的积累、神经退行性疾病的开始，或者是多种因素的结合。
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